Semin Speech Lang 2020; 41(03): 221-231
DOI: 10.1055/s-0040-1712115
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assumptions about Decision-Making Capacity and Aphasia: Ethical Implications and Impact

Aura Kagan
1   Applied Research and Education, Aphasia Institute, Ontario, Canada
Elyse Shumway
2   Education, Training and Resources, Aphasia Institute, Ontario, Canada
Sheila MacDonald
3   Sheila MacDonald and Associates, Ontario, Canada
4   School of Rehabilitation Science, McMaster University, Ontario, Canada
5   Speech-Language Pathology, University of Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
25 June 2020 (online)


This article explores the issue of aphasia and decision-making within the context of clinical ethics and patient rights. The cases described illustrate the danger of making assumptions about the inherent competence of people with aphasia and the life-altering consequences if no attempt is made to “accommodate” or support communication when competence may be masked by aphasia. Speech-language pathologists have a moral obligation and a key role to play in providing communication support that may serve to reveal a person's intact capacity to make specific decisions, as well as in supporting the steps involved in the decision-making process. This role also extends to providing guidance, education, and training for others involved in evaluating the decision-making capacity of people with aphasia. Communication support strategies useful at each stage of the decision-making process are detailed.

Financial Disclosures

Aura Kagan receives a full-time salary from the Aphasia Institute (ongoing) and has no nonfinancial disclosures related to this article.

Elyse Shumway receives consulting fees from the Aphasia Institute (ongoing) and has no nonfinancial disclosures related to this article.

Sheila MacDonald is the author of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) and has financial interest in CCD Publishing.